Vaccination
Bacillus Calmette–Guérin (historically Vaccin Bilié de Calmette et Guérin commonly referred to as Bacille de Calmette et Guérin or BCG) is a vaccine against tuberculosis and for the treatment of some bladder cancers.
It is prepared from a strain of the attenuated (virulence-reduced) live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its virulence in humans. Because the living bacilli evolve to make the best use of available nutrients, they become less well-adapted to human blood and can no longer induce disease when introduced into a human host. Still, they are similar enough to their wild ancestors to provide some degree of immunity against human tuberculosis. The BCG vaccine can be anywhere from 0 to 80% effective in preventing tuberculosis for a duration of 15 years; however, its protective effect appears to vary according to geography and the lab in which the vaccine strain was grown.
It is on the World Health Organization’s List of Essential Medicines, a list of the most important medication needed in a basic health system.
Medical uses
The main use of BCG is for vaccination against tuberculosis. BCG vaccine can be administered after birth intradermally.BCG vaccination is recommended to be given intradermally. A previous BCG vaccination can cause a false positive Mantoux test, although a very high-grade reading is usually due to active disease.
The age of the patient and the frequency with which BCG is given has always varied from country to country.
WHO BCG policy: The WHO recommend BCG be given to all children born in countries highly endemic for TB because it protects against miliary TB and TB meningitis.INDIA: BCG vaccine needs to be given immediately after birth and catch.
Method of administration
BCG is given as a single intradermal injection at the insertion of the deltoid. If BCG is accidentally given subcutaneously, The characteristic raised scar BCG immunization leaves is often used as proof of prior immunization
Routine vaccination:
Minimum age: birth
• Administer monovalent HepB vaccine to all newborns within 48 hours of birth.
• Monovalent HepB vaccine should be used for doses administered before age 6 weeks.
• Administration of a total of 4 doses of HepB vaccine is permissible when a combination vaccine containing HepB is administered after the birth dose.
• Infants who did not receive a birth dose should receive 3 doses of a HepB containing vaccine starting as soon as
feasible.
• The ideal minimum interval between dose 1 and dose 2 is 4 weeks, and between dose 2 and 3 is 8 weeks. Ideally, the final (3rd or 4th) dose in the HepB vaccine series should be administered no earlier than age 24 weeks
and at least 16 weeks after the first dose,whichever is later.
• Hep B vaccine may also be given in any of
the following schedules: Birth, 1, & 6 mo,Birth, 6 and 14 weeks; 6, 10 and 14 weeks; Birth, 6 ,10 and 14 weeks, etc. All schedules are protective.
Routine vaccination:
Birth dose of OPV usually does not lead to
VAPP.
• OPV in place of IPV, if IPV is unfeasible, minimum 3 doses.
• Additional doses of OPV on all SIAs.
• IPV: Minimum age – 6 weeks.
• IPV: 2 instead of 3 doses can be also used if primary series started at 8 weeks and the interval between the doses is kept 8 weeks.
• No child should leave your facility without polio immunization (IPV or OPV), if indicated by the schedule!!
Routine vaccination:
Minimum age: 6 weeks
• The first booster (4thth dose) may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose.
• DTaP vaccine/combinations should preferably be avoided for the primary series.
• DTaP may be preferred to DTwP in children with history of severe adverse effects after previous dose/s of DTwP or children with neurologic disorders.
• First and second boosters may also be of DTwP. However, considering a higher reactogenicity, DTaP can be considered for the boosters.
• If any ‘acellular pertussis’ containing vaccine is used, it must at least have 3 or more components in the product.
• No need of repeating/giving additional doses of whole-cell pertussis (wP) vaccine to a child who has earlier completed their primary schedule with acellular pertussis
(aP) vaccine-containing products.
Routine vaccination:
Minimum age: 7 years (Adacel® is approved for 11-64 years by ACIP and 4 to 64 year olds by FDA, while Boostrix® for 10 years and older by ACIP and 4 years of age and older by FDA in US).
• Administer 1 dose of Tdap vaccine to all adolescents aged 11 through 12 years.
• Tdap during pregnancy:One dose of Tdap vaccine to pregnant mothers/adolescents during each pregnancy (preferred during 27 through 36 weeks gestation) regardless of number of years from prior Td or Tdap
vaccination.
Routine vaccination:
• Minimum age: 6 weeks
• Primary series includes Hib conjugate vaccine at ages 6, 10, 14 weeks with a booster at age 12 through 18 months.
Minimum age: 6 weeks
• Both PCV10 and PCV13 are licensed for children from 6 weeks to 5 years of age (although the exact labeling details may differ by country). Additionally, PCV13 is
licensed for the prevention of pneumococcal diseases in adults >50 years of age.
• Primary schedule (For both PCV10 and PCV13): 3 primary doses at 6, 10, and 14 weeks with a booster at age 12 through 15 months.
Minimum age: 2 years
• Not recommended for routine use in healthy individuals. Recommended only for the vaccination of persons with certain high-risk conditions.
• Administer PPSV at least 8 weeks after the last dose of PCV to children aged 2 years or older with certain underlying medical conditions like anatomic or functional
asplenia (including sickle cell disease), HIV infection, cochlear implant or cerebrospinal fluid leak.
• An additional dose of PPSV should be administered after 5 years to children with anatomic/functional asplenia or an
immunocompromising condition.
• PPSV should never be used alone for prevention of pneumococcal diseases amongst high–risk individuals.
• Children with following medical conditions for which PPSV23 and PCV13 are indicated in the age group 24 through 71 months:
o Immunocompetent children with chronic heart disease (particularly cya-notic congenital heart disease and cardiac failure); chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy), diabetes mellitus cerebrospinal fluid leaks; or cochlear
implant.
o Children with anatomic or functional
asplenia (including sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, or splenic dysfunction);
o Children with immuno-compromising conditions: HIV infection, chronic renal failure and nephrotic syndrome, diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas and Hodgkin disease; or solid organ transplantation,
congenital immunodeficiency.
Routine vaccination:
Minimum age: 6 weeks for both RV-1[Rotarix] and RV-5 [RotaTeq / RotaVac])
• Only two doses of RV-1 are recommended at present
• RV1 should preferably be employed in 10 and 14 week schedule, instead of 6 and 10 week; the former schedule is found to be far more immunogenic than the later
• If any dose in series was RV-5 or vaccine product is unknown for any dose in the series, a total of 3 doses of RV vaccine should be administered.
Routine vaccination:
Minimum age: 9 months or 270 completed days.
• Administer the first dose of MMR vaccine at age 9 through 12 months, and the second dose at age 15 through 18 months.
• The 2nd dose must follow in 2nd year of life. However, it can be given at anytime 4-8 weeks after the 1st dose
• No need to give stand-alone measles vaccine.
Routine vaccination:
Minimum age: 12 months
• Administer the first dose at age 15 through 18 months and the second dose at age 4 through 6 years.
• The second dose may be administered before age 4 years, provided at least 3 months have elapsed since the first dose. If the second dose was administered at least 4
weeks after the first dose, it can be accepted as valid.
• The risk of breakthrough varicella is lower if given 15 months onwards.
Routine vaccination:
Minimum age: 12 months
• Killed HepA vaccine: Start the 2-dose HepA vaccine series for children aged 12 through 23 months; separate the 2 doses by 6 to 18 months.
• Live attenuated H2-strain Hepatitis A vaccine: Single dose starting at 12 months and through 23 months of age.
Routine vaccination:
Both Vi-PS conjugate and Vi-PS (polysaccharide) vaccines are available
• Minimum ages:
o Vi-PS (Typbar-TCV® ): 6 months;
o Vi-PS (polysaccharide) vaccines: 2 years
• Vaccination schedule:
• Typhoid conjugate vaccines (Vi-PS): Single dose at 9-12 through 23 months and a booster during second year of life
• Vi-PS (polysaccharide) vaccines dose at 2 years; revaccination every 3 years;
• Currently, two typhoid conjugate vaccines, Typbar-TCV® and PedaTyph® available in Indian market;
• PedaTyph® is not yet approved; the recommendation is applicable to Typbar- TCV® only
• An interval of at least 4 weeks with the MMR vaccine should be maintained while administering Typbar-TCV® vaccine
• Primary dose of conjugate vaccine should follow a booster at 2 years of age
• Either Typbar-TCV® or Vi-polysaccharide (Vi-PS) can be employed as booster;
• Typhoid revaccination every 3 years, if Vipolysaccharide vaccine is used
• No evidence of hypo-responsiveness on repeated revaccination of Vipolysaccharide vaccine so far
• Need of revaccination following a booster of Typbar-TCV® not yet determined.
Routine vaccination:
Minimum age: 6 months for trivalent inactivated influenza vaccine (TIV)
• Recommended only for the vaccination of persons with certain high-risk conditions.
• First time vaccination: 6 months to below 9 years: two doses 1 month apart; 9 years and above: single dose
• Annual revaccination with single dose.
• Dosage (TIV) : aged 6–35 months 0.25 ml; 3 years and above: 0.5 ml
• For children aged 6 months through 8 years: Administer 2 doses (separated by at least 4 weeks) to children who are receiving influenza vaccine for the first time.
• All the currently available TIVs in the country contain the ‘Swine flu’ or ‘A (H1N1)’ antigen; no need to vaccinate separately.
• Best time to vaccinate:
o As soon as the new vaccine is released
and available in the market
o Just before the onset of rainy season.
Routine vaccination:
Minimum age: 9 years
• HPV4 [Gardasil] and HPV2 [Cervarix] are licensed and available.
• Only 2 doses of either of the two HPV vaccines (HPV4 & HPV2) for adolescent/ preadolescent girls aged 9-14 years;
• For girls 15 years and older, and immunocompromised individuals 3 doses are recommended
• For two-dose schedule, the minimum interval between doses should be 6 months.
• Either HPV4 (0, 2, 6 months) or HPV2 (0, 1, 6 months) is recommended in a 3-dose series for females aged 15 years and older
• HPV4 can also be given in a 3-dose series for males aged 11 or 12 years, but not yet licensed for use in males in India.
• The vaccine series can be started beginning at age 9 years.
• For three-dose schedule, administer the 2nddose 1 to 2 months after the 1stdose and the 3rddose 6 months after the 1stdose (at least 24 weeks after the first dose).
